Fungi (EXAM 3)

Question 1

What type of cells are invaded by fungi?

Answer 1

-dead cells of the stratum corneum layer of
the skin
-hair and nails

Question 2

Most common form of tinea?

Answer 2

Tinea pedis (feet)

Question 3

How is tinea spread among people?

Answer 3

Person-to-person or fomites (Towels, showers, clothes)

Question 4

Risk factors for fungi

Answer 4

Skin trauma
Immune suppression (diabetes)
Summer and tropical climate
Sweating and occlusive clothing, poor circulation
poor nutrition and hygiene

Question 5

Tinea capitis

Tinea corporis

Answer 5

Tinea capitis - head

Tinea corporis - body (Ringworm - oval shape)

Question 6

Tinea cruris

Tinea pedis

Tinea unguium

Answer 6

Tinea cruris - groin

Tinea pedis - foot

Tinea unguium - nail

Question 7

Signs and Symptoms of Fungi

Answer 7

Malodor
Thickened skin, scaling
Maceration, skin erosion
Vesicular rash (fluid-filled blisters)
Inflammation
Cracks, fissures, crusting
Itching, stinging, pain

Question 8

Tinea Capitis

Answer 8

single hair follicles -> spreads
Tinea favus: patchy hair loss

-May lead to secondary bacterial infections, atrophy, scarring, alopecia
-common in children

Question 9

Two types of Tinea Capitis

Answer 9

Non-inflammatory: Yellow scaling

Inflammatory: Pustules to kerions

Question 10

Tinea Corporis

Answer 10

-ringworm shape, inflammed border
-can affect trunk and limb, also any area

Question 11

Risk factors of Tinea Corporis

Answer 11

-Children in daycare centers
-Contact sport (wrestling)
-Hot, humid climate
-Obesity (skin falts)

Question 12

Tinea Cruris
(tighs and groin)

Answer 12

-Medial and upper thighs and groin are
-Acute lesions are bright red (inflamed)
-bilateral

-avoid wood or synthetic fibers/underwear

Question 13

Tinea Pedis

Answer 13

-in lateral toe webs and sole of the foot
-> White, scaly patches; Red, inflamed area with demarcated borders

-aggravated by damp socks and shoes; bathing facilities

Question 14

Tinea Unguium

Answer 14

Fungal infection of nails and nail beds
-Toenails become yellow, thick, and brittle and lose their shiny luster
-nail may separate from nail bed

Question 15

When to refer

Answer 15

-cant trace back the cause, an odd spot with less exposure
-severe (inflamed, secondary bacterial infection, fever)
-immunocompromised (grey area) (diabetes, systemic infection, immunodeficiency) (grey area - check-ups)

-treatment hasn’t worked or gotten worse
-patients under 2 y

Question 16

Treatment duration

Answer 16

-Tinea corporis (core): 2-4 weeks
-Tinea cruris: 1-2 weeks
-Tinea pedis: 2-4 weeks

-Tinea capitis (head): REFER for inspection
-Tinea unguium: REFER - takes a lot of time to treat, no OTC products

Question 17

How to treat Tinea pedis (athlete’s foot)
small vesicles, scaling between toes, NO inflammation

Answer 17

Topical antifungal agent

Question 18

How to treat Tinea pedis (athlete’s foot)
Inflammatory lesions

Answer 18

Initial (drying - Astringent): Aluminum acetate solution, BID-TID up to 1 week
Secondary: Topical antifungal agent

Question 19

How to treat Tinea pedis (athlete’s foot)
Wet, Soggy, No fissure

Answer 19

Initial: Aluminum chloride 20-30%, BID up to 1 week
Secondary: Topical antifungal agent

Question 20

How to treat Tinea pedis (athlete’s foot)
Wet, Soggy, With fissure

Answer 20

Initial: Aluminum chloride 10%, BID for 1 week
Secondary: Aluminum chloride 20-30%, BID for up to one week
Tertiary: Topical antifungal agent

Question 21

OTC product athletes’ foot

Answer 21

-Clotrimazole Nitrate 1% - LOTRIMIN
-Miconazole Nitrate 2% - Cruex Spray Powder, Desenex Liquid Spray, Micatin Cream, Lotrimin AF Powder

– Tinea pedis: twice daily for 4 weeks
– Tinea corporis: twice daily for 4 weeks
– Tinea cruris: twice daily for 2 weeks

Question 22

OTC products with shorter duration! (more expensive)

Answer 22

-Terbinafine Hydrochloride 1% - LAMISIL
-Butenafine Hydrochloride 1% - LOTRIMIN ULTRA
-Tolnaftate 1% ??

DO NOT USE for patients under 12 y

Question 23

Which dosage form is preferred for dry/scaly rash?

Answer 23

cream or solution (not for broken skin)

Question 24

Which dosage form is preferred for a macerated, erosive rash?

Answer 24

Gels and sprays

Question 25

Which dosage form is preferred for areas of sweat on the trunk?

Answer 25

POWDERS to keep it dry

on trunk -> areas of sweat (skin falts) for prevention
-in combination with antifungal agents

Question 26

What are the counseling points?

Answer 26

-Prevent spreading
-topical products to clean, dry skin
-continue full treatment! even with improvement
-Symptoms should subside within 1 week
-No improvement or worsening -> REFER

Question 27

Which products to use for wet, soggy Tinea pedis?

Answer 27

-Astringent - Aluminium slats - drying (too much is irritating, can cause itching and sting)
-> Aluminium acetate (DOMEBERO)
-in combination with an antifungal agent

Question 28

Cosmetic product

Answer 28

-Dr. Scholl’s Fungal Nail Revitalizer System - NOT ANTIFUNGAL
-Calcium carbonate and urea
-shroffs of the dead part of the nail to make it look shinier

Question 29

Other product

Answer 29

-Tea Tree Oil (grade C):
– Antimicrobial activity toward Candida albicans

-can cause Contact dermatitis (another rash)
-oral ingestion is fatal!

Question 30

Other product

Answer 30

Mentholated Ointment (Vicks® VapoRub)
– Effective.. after 48 weeks of therapy

-Honey mixture: Honey, olive oil, beeswax (1:1:1)
-antimicrobial property

Question 31

Tinea infection for referral

Answer 31

Tinea capitis (head)

Tinea unguium (toe)